Therapy and management of choanal atresia

Introduction:

Congenital bilateral choanal atresia is a pediatric emergency. Due to its rare incidence (1/24,000) there are no consistent recommendations for surgical treatment and postoperative management.

Methods:

Between 2002 and 2018, twenty patients with choanal atresia were surgically treated. In case of bony stenosis the choanae were opened with a drill and a placeholder was inserted in succession. Patients were followed up for approximately one year.

Results:

Eight patients suffered from bilateral choanal atresia and had to be treated surgically within the first few days of life. Three other children were revised due to bilateral re-stenosis after an initial operation performed alio loco. Nine operations were performed for unilateral stenosis in childhood.

In non-syndromal children, discharge was possible within one week postoperatively. Children were monitored at home by means of a home monitor, the placeholders were cleaned with tacholiquin and aspirated three times a day by the parents. The placeholders were usually left for 6 – 8 weeks. The suction incapacity of children with bilateral choanal atresia could no longer be observed after removal of the placeholders.

Re-stenosis was seen in three cases, and occurred only in the group of newborns with bilateral atresia with placeholders < 14 Charriere in size.

Conclusion:

The surgical opening of a choanal atresia with subsequent placeholder insertion and adequate aftercare is a gentle and safe method, which largely avoids hospitalization of the young patients. In order to further reduce the rate of re-stenoses a placeholder of size greater than 14 Charriere should be used, and if this is not initially possible one should consider changing the placeholder to a size 14 during the course of the treatment.

Publication History

Publication Date:
23 April 2019 (online)